title: Hemodynamic effects of levobupivacaine after pediatric caudal anesthesia evaluated by transesophageal doppler.
abstract: BACKGROUND
  The aim of this study is to determine if there are significant differences in hemodynamic effects between combined general-regional anesthesia using levobupivacaine 0.25% 2 ml x kg(-1) via the caudal route in comparison with balanced general anesthesia using continuous infusion of remifentanil in young children undergoing genitourinary surgery.
  
  
  METHODS
  62 ASA I-II pediatric patients (12 female, 50 male) aged 6 months to 7 years undergoing genitourinary surgery were included in the study. Patients were randomly allocated into one of two groups of 31 patients each. Group Caud received caudal blockade with levobupivacaine 0.25% 2 mg x kg(-1) in combined general-regional anesthesia and Group Gen received balanced general anesthesia with remifentanil. The noninvasive hemodynamic parameters were measured in each group 5 min after induction of general anesthesia or caudal block (Tcaud), after further 5 min coincident with skin incision (Tsi), 10 min after skin incision (T10i), at the end of surgical procedure (Tend). The time between Tcaud and Tsi was 10 min and the measurements during the interval time T10i-Tend were performed every 15 min according to the duration of surgical procedures.
  
  
  RESULTS
  There was a decrease in all measured hemodynamic parameters at skin incision. The decreases occurred in both groups with those in the caudal group occurring at skin incision and those in the balanced anesthesia group occurring at 10 min after skin incision. These variations showed no significant differences for any of the stated outcomes; neither between the groups at each time point nor in the caudal in comparison with baseline measurements.
  
  
  CONCLUSIONS
  Using transesophageal Doppler no differences in hemodynamic parameters could be detected between balanced general anesthesia with either caudal levobupivacaine or remifentanil infusion. Both techniques showed good hemodynamic stability with only minor changes from baseline over time which are unlikely to be of clinical significance except possibly in patients with preexisting cardiovascular compromise. Other studies with noninvasive monitoring in a larger population are required to better understand the consequences of caudal blockade on CO and on regional blood flow in infants.
authors.affiliation: University Department of Anesthesia and Intensive Care, University Hospital Ospedali Riuniti of Foggia, Italy, University of Foggia, Italy. dario.galante@tin.it
authors.forename: Dario
authors.initials: D
authors.lastname: Galante
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pellico
authors.forename: Salvatore
authors.initials: S
authors.lastname: Meola
authors.forename: Antonio
authors.initials: A
authors.lastname: Caso
authors.forename: Antonella
authors.initials: A
authors.lastname: De Capraris
authors.forename: Rosella
authors.initials: R
authors.lastname: Milillo
authors.forename: Cristian
authors.initials: C
authors.lastname: Mirabile
authors.forename: Maria
authors.initials: M
authors.lastname: Olivieri
authors.forename: Gilda
authors.initials: G
authors.lastname: Cinnella
authors.forename: Michele
authors.initials: M
authors.lastname: Dambrosio
mesh_terms: D000763:Anesthesia, Caudal / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods; D000771:Anesthesia, Intravenous / Q000379:methods; D018686:Anesthetics, Intravenous / Q000494:pharmacology; D000779:Anesthetics, Local / Q000494:pharmacology*; D002045:Bupivacaine / Q000031:analogs & derivatives / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007223:Infant; D000077554:Levobupivacaine; D008297:Male; D010880:Piperidines / Q000494:pharmacology; D000077208:Remifentanil; D013997:Time Factors
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D010880:Piperidines; D000077554:Levobupivacaine; D000077208:Remifentanil; D002045:Bupivacaine